Most Relevant Information
Provider Data
| NPI Number: | 1003664632 |
| Provider Name: | MARIAH KAITLYN BOUDREAUX MSW, LCSW, APHSW-C |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | C015547 |
Most Important Dates
| Enumeration Date: | 05/08/2024 |
| Last Updated: | 05/08/2024 |
Provider Practice Location
555 S. MANGUM ST
SUITE 100, #5035
DURHAM
NC
27701
Practice Location Phone/Fax
| Phone: | 9194736888 |
| Fax: |
Provider Mailing Location
555 S. MANGUM ST
SUITE 100, #5035
DURHAM
NC
27701
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |